Chronic Kidney Disease&Stages

A Joint Commission-Accredited Program

UC San Diego Health is a national and international leader in the care of people aged 18 years and older with chronic kidney disease stages 2-5. In 2010, our program received the nation’s first chronic kidney disease certificate of distinction from The Joint Commission for helping patients achieve long-term success by delivering:

Our program has earned the Gold Seal of Approval from The Joint Commission, which signifies the highest level of quality care for patients.

Tailored treatment plans that include both holistic (e.g., diet therapy) and conventional therapies

Self-management support

Coordinated care from diagnosis to management based on evidence-based guidelines defined by theNational Kidney Foundation

Treating chronic kidney disease is a complex process, often requiring management of coinciding conditions (e.g., diabetes, hypertension) that can increase risk for cardiovascular disease and death.

Our multidisciplinary team has the expertise, support and tools that can help you effectively manage chronic kidney disease and its complications.

​Chronic kidney disease (CKD) affects an estimated 26 million adults in the U.S. – and millions more are at risk. It is an irreversible condition that increases risk for heart and blood vessel disease. While there is no cure for chronic kidney disease, there are treatment and preventive strategies to slow disease progression and avoid end-stage renal disease.

About Chronic Kidney Disease

The kidneys have an important function of filtering waste and removing excess fluid out of the blood, balancing minerals, and helping to control blood pressure.

Chronic kidney disease is the gradual loss of kidney function over time. It can take months or years for the condition to develop. As the disease progresses, wastes accumulate to unhealthy levels in your blood, which can make you feel ill.

This buildup can lead to complications such as:

Cardiovascular disease

Poor bone health

Nerve damage

Depression

Low blood cell count (anemia)

High blood pressure (hypertension)

Vitamin D deficiency

Malnutrition

Kidney failure

Early Screening and Intervention

The goal of treatment is to keep chronic kidney disease from progressing to kidney failure. Early detection and intervention is essential. Note that routine screening is NOT advised for those who are under 50 and considered to be low risk.

We recommend early, routine screenings for those who:

Have hypertension

Have diabetes

Have cardiovascular disease

Have a personal history of cancer or use of nephrotoxic medications

Have a family history of chronic kidney diseases

Are African American, American Indian, Alaska Native, or Hispanic (these groups have a higher rate of diabetes and high blood pressure, and therefore an increased risk of developing kidney failure).

Diagnosis

We use two simple tests to check kidney function:

Urine test — to check for protein
Protein in the urine can be a sign of kidney disease. When the filters in the kidneys are damaged, protein may leak into the urine as a result. This test is known by several names, including proteinuria, urine albumin-to-creatinine ratio, microalbuminuria, and macroalbuminuria.

​GFR = 60-89 mL/min/1.73m2
More albumin leaks into the urine. The kidney’s filtering function begins to decrease. As filtration fails, the body begins to retain more waste. Blood pressure may also rise during this time as a result of developing kidney damage.

Causes and Risk Factors

The top two causes of chronic kidney disease are diabetes and high blood pressure. Together they account for nearly two-thirds of all cases of chronic kidney disease. The other one-third of cases may be a result of other conditions that can damage the kidney:

Glomerulonephritis

Birth defects of the kidney (e.g., polycystic kidney disease)

Diseases that affect the body’s immune system (e.g., lupus)

Recurrent urinary tract infections or kidney stones

Acute kidney injury

Certain medications

Diabetes and Chronic Kidney Disease

Diabetes is the leading cause of chronic kidney disease and kidney failure in the U.S. And the number of people with diabetes is growing – it’s predicted that diabetes will soon account for half of all cases of kidney failure.

If you have diabetes and chronic kidney disease, getting blood glucose under control is critical. Learn more about diabetes self-management at UC San Diego Health.

Kidney damage rarely occurs in the first 10 years of diabetes. However, many people are not aware of having diabetes for years before diagnosis, and may already have kidney damage by the time they are diagnosed with diabetes.

People who have had diabetes for more than 25 years without signs of kidney disease have a lower risk of ever developing it.

Preventing and slowing kidney disease in those with diabetes may involve:

Blood pressure medicines

Thorough management of blood glucose

A moderate- to low-protein diet (a high-protein diet can be harmful in a person with diabetes as it can increase protein in the urine and may accelerate loss of kidney function)

Controlling of potential excessive acidity in the body (metabolic acidosis)

The National Institutes of Health (NIH) and the American Diabetes Associationrecommend that people with diabetes get screened annually for kidney disease. ​

High Blood Pressure and Chronic Kidney Disease

Hypertension, or high blood pressure, can damage the blood vessels inside the kidneys, hindering their ability to function. This can lead to waste and fluid buildup, which can raise blood pressure even more. This dangerous cycle can progress kidney damage and increase your risk for cardiovascular disease and kidney failure. Cardiovascular disease is currently the leading cause of death in people with chronic kidney disease.

Home Blood Pressure Monitoring
Frequent blood pressure monitoring allows more opportunities to spot blood pressure that is higher than desired. It can also help quickly determine the effectiveness of a new blood pressure medication.

We provide blood pressure monitors and cuffs to patients who cannot afford them, as well as training on how and when to use them. By making the management of hypertension easy and convenient, we are able to help you gain better control of your blood pressure and, consequently, better control of chronic kidney disease.

Treatment

Since there is no cure for chronic kidney disease, the goal of treatment is to keep the disease from progressing to kidney failure, or end-stage renal disease (ESRD).

Our team promotes a holistic approach that embraces both conventional and alternative therapies.

Review of all your medications (prescription and over the counter) to make sure they are not harmful to your kidneys, as well as adjustment of the doses (to the level of your current kidney function)

Patient education classes

Referrals for vascular surgery, dialysis, and transplantation program

Psychosocial support in dealing with a chronic illness

We recognize the importance you play in your health. By providing continuing, hands-on information and self-management tools, we empower you to play an active role in the decision-making process.

You can help avoid complications by staying up to date on vaccinations, following the recommendations made by your doctor, and communicating any issues regarding your current treatment plan with your care team. How often you meet with the doctor depends on the rate of your chronic kidney disease progression.

Diet Therapy

Changing your diet can help prevent and treat common complications of chronic kidney disease.

Our kidney health-focused dietician provides instruction on healthy eating and can help tailor your diet plan to suit your specific needs. Also available are dietician-led field trips to the grocery store where you can receive firsthand knowledge of what kinds of foods to buy.

Lifestyle Interventions

Regular exercise: Aerobic and strength training can help control glucose (in those with diabetes) and prevent cardiovascular disease. It can help achieve ideal blood pressure control, weight loss (if desired) and emotional well-being.

Losing weight: Kidneys have to work harder than normal in people who are overweight. UC San Diego Health’s Bariatric and Metabolic program offers at-home weight-loss kits and surgical and non-surgical and weight management programs.

Medicines

Most people with chronic kidney disease need to take medication to help slow disease progression.

Ensuring that other medications you may be taking for conditions do not interfere with your chronic kidney disease medicines is critical. At each doctor visit you will meet with our team pharmacist who may review or update your medications.

Dialysis

The ultimate goal of chronic kidney disease treatment is to help you effectively manage your condition and keep you off dialysis. We try to bypass dialysis when possible by referring patients directly to transplantation.

Determining if you need to begin dialysis is based on several factors including:

How you feel

If there is something life threatening on your labs

The level of your kidney function

Low level of kidney function by itself (even if below 10 percent normal) does not automatically place you on dialysis. If the rate of decline in your GFR is slow, you may be able to stay off dialysis for quite some time, or even avoid it altogether.